A randomised study for optimising crossover from ticagrelor to clopidogrel in patients with acute coronary syndrome

Ali Pourdjabbar; Benjamin Hibbert; Aun-Yeong Chong; Michel R. Le May; Marino Labinaz; Trevor Simard; F. Daniel Ramirez; Peter Lugomirski; Ronnen Maze; Michael Froeschl; Christopher Glover; Alexander Dick; Jean-Francois Marquis; Jordan Bernick; George Wells; Derek Y. F. So; the CAPITAL Investigators; on behalf of

doi:10.1160/TH16-04-0340

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2017; 117(02): 303-310
DOI: 10.1160/TH16-04-0340

Cellular Haemostasis and Platelets

Schattauer GmbH

A randomised study for optimising crossover from ticagrelor to clopidogrel in patients with acute coronary syndrome

The CAPITAL OPTI-CROSS Study^[*]

Ali Pourdjabbar

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Benjamin Hibbert

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Aun-Yeong Chong

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Michel R. Le May

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Marino Labinaz

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Trevor Simard

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

F. Daniel Ramirez

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Peter Lugomirski

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Ronnen Maze

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Michael Froeschl

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Christopher Glover

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Alexander Dick

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Jean-Francois Marquis

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Jordan Bernick

²Cardiovascular Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

George Wells

²Cardiovascular Methods Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

Derek Y. F. So

¹Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

,

the CAPITAL Investigators

› Author Affiliations

Abstract

Summary

Ticagrelor has been endorsed by guidelines as the P2Y₁₂ inhibitor of choice in patients with acute coronary syndrome. Clinically, some patients on ticagrelor will require a switch to clopidogrel; however, the optimal strategy and pharmacodynamics effects of switching remain unknown. Patients with an indication to switch were randomly assigned to either a bolus arm (Clopidogrel 600 mg bolus followed by 75 mg daily, n=30) or a no-bolus arm (Clopidogrel 75 mg daily, n=30). Blood samples were collected at baseline, 12, 24, 48, 54, 60 and 72 hours (h) for assessment of platelet reactivity. The primary outcome was P2Y₁₂ reactivity units (PRU) at 72 h. Secondary outcomes included: PRUs at each time point, incidence of high on-treatment platelet reactivity (HPR), major adverse cardiac events (MACE) and TIMI bleeding at 30 days. Serial PRUs increased after switching to clopidogrel in both groups. At 72 h, no difference in PRU was observed (165.8 ± 71.0 vs 184.1 ± 67.7, bolus vs no bolus, respectively, p=0.19). At 48 h the PRUs were significantly lower in the bolus arm (114 ± 73.1 vs 165.1 ± 70.5, respectively; p=0.0076) and at 72 h, there was a significant reduction in incidence of HPR (26.7 % vs 56.7 %, p=0.02). No differences in MACE or TIMI bleeding were observed. Although a bolus strategy was not associated with improved platelet inhibition at 72 h; at 48 h, platelet inhibition was superior with reduced incidence of HPR. Larger studies will be required to determine its clinical significance. Until then, decision for giving a bolus of clopidogrel at the time of a switch may in part be dependent on the indication for switching, especially if there are concerns for bleeding risk.

Supplementary Material to this article is available online at www.thrombosis-online.com.

Keywords

Pharmacodynamics - acute coronary syndrome - platelet function - ticagrelor - clopidogrel

Full Text

References

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Supplementary Material

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